April 2013 Archives

An idea that was first proposed in 2005 in both the failed Medical Error Disclosure and Compensation Act and in passed legislation that created Patient Safety Organizations may be nearing implementation. A group of legal and medical professionals is in discussions over the idea of using medical malpractice lawsuits as teaching tools to reduce the risk of misdiagnosis and other errors. This project is taking place in New York, but success could mean implementation in other states, including Massachusetts.The idea is that attorneys for the plaintiff and defendant will sit down with a judge after a case's conclusion and create a narrative. Identifying information would then be stripped out of the narrative so that it could be uploaded to a central clearinghouse for use by hospitals, universities and other institutions. The impetus came from a lawyer who noted that much useful information presented during malpractice trials ends up "being buried" instead of being used to enhance patient safety.

An Emory University School of Medicine assistant professor estimates that a wrong-patient error occurs in around one of every 10,000 radiological examinations. These errors could put Boston patients at risk of serious health problems and doctors at risk of medical malpractice lawsuits by resulting in misdiagnosis or a missed diagnosis of cancer. A new study produced for the American Roentgen Ray Society annual meeting has investigated a solution that could greatly reduce the number of errors. Instead of using a folder of X-rays identified only by patient paperwork, files would contain a photo of the patient for quicker recognition. Two experiments carried out in the study confirmed that this practice significantly reduces errors. Ten radiologists were first selected to receive 20 images with and without identifying photos. Each set of X-rays included deliberately mismatched images and data. Errors were only spotted 13 percent of the time without photos compared to 64 percent of the time with attached photos.

A week after a supposedly routine abortion procedure, the woman who sought the abortion for medical reasons found out she was still pregnant. Massachusetts residents may have heard of the resulting surgeon malpractice lawsuit, which alleges the error resulted in emotional damages related to the threat to her life. The woman gave birth to the child and now claims she is pleased with the result. However, the error resulted in worries for her life and the fate of her already born child as well as numerous stops to the emergency room, several three to five day hospital stays and the assistance of a physician with advanced knowledge of high-risk pregnancy. The woman's condition is known as uterine didelphys. The uterus essentially has two compartments, each with its own cervix, and one is stronger than the other. The fetus in this pregnancy had implanted into the weaker compartment, unlike her first child.

Hyperbaric oxygen therapy treatment (HBOT) and several other "non-invasive procedures" may offer hope for traumatic brain injury patients in Massachusetts and across the nation. Unfortunately, as one survivor has found, these treatments are expensive and often not covered by medical insurance policies. Brain injuries come in several forms, and this 22-year-old survivor has been diagnosed with diffuse axonal brain injury. The condition may impair the ability to walk and speak, remember details and perform other basic activities that are often taken for granted by healthy individuals. This survivor is about to embark on a second series of HBOT treatments in Massachusetts. HBOT in this case will be delivered five days a week for a total of 80 times. Specially formulated vitamins are also being used to assist in the repair of brain tissue. These treatments, along with neurofeedback and other procedures, have allowed the 22-year-old to walk again and make other improvements.

Two studies published in the Journal of the American Medical Association may surprise people in Massachusetts and around the country. These studies indicate that when resident physicians are working the shorter shifts that have been recommended by oversight boards, they tend to make more errors. These shifts are a movement from the traditional 30 hours to 16 hours. These studies also show that shorter hours do not improve residents' depression rates and that they are getting more sleep.The working hours of medical residents are not federally regulated but are set by the Accreditation Council for Graduate Medical Education. This group has been working on adjusting residents' work hours since 2003. Certainly some of the medical errors that the Council was trying to avoid were those of misdiagnosis. However, one expert states that the cause for the increase in errors is that the patient is being "handed off" more frequently between different professionals. It was also pointed out that the teaching hospitals are not increasing staff, thereby forcing the doctors to do more work in fewer hours, which is a stressor.

Doctors in poverty-stricken areas have a new option for reducing the risk of brain damage in oxygen-deprived children. The condition is referred to as hypoxic ischemic encephalopathy. Though placental problems and umbilical knotting can happen during any child delivery, the risks of birth injury and brain damage are compounded in developing areas by malnutrition, anemia and lack of trained delivery personnel. Risks are also greater in developing regions of the world due to lack of expensive medical devices commonly found in Massachusetts and other developed world hospitals.To get around this problem, undergraduate students with the Center for Bioengineering Innovation and Design at Johns Hopkins designed a $40 instrument capable of performing similarly to $12,000 hospital cooling units. The treatment involves reduction of the newborn's temperature by six degrees over three days. Research shows that, if done quickly following birth, brain injury may be prevented.

According to the American Academy of Neurology (AAN), the increasingly common trend of neuroenhancement by young students is not good. Neuroenhancement is when healthy individuals rely on prescription drugs to increase their mental performance, and a study by AAN doctors claims that there are serious ramifications. Many students allegedly complain of symptoms commonly found in sufferers of hyperactivity disorders in order to gain doctor prescriptions for Adderall, an amphetamine, or similar stimulants. In some cases, doctors even prescribe these drugs upon patient request.Hundreds of independent studies reviewed by the AAN also support the idea that stimulant use is rising among adolescent age groups. In addition to increases in reports of ADHD brought up by parents, almost 3 percent of 10th-grade students surveyed in 2008 admitted to taking stimulants without a doctor's prescription. Although AAN doctors admit that ADHD is a valid condition that medication can help with, they also point out that the preponderance of data serves as evidence that misdiagnosis and overdiagnosis are serious problems.

Massachusetts residents who are considering knee replacement surgery may be interested to know that an error occurred during this procedure at San Coronado Hospital in California on April 2012 due to a vendor rep taking the wrong box off a shelf. The patient then had to have a second knee surgery to correct the placement of the wrong tibial joint. The facts reported stated that a representative for the manufacturer of replacement knee joints was the person who retrieved the box with the wrong joint in it and gave it to the surgeon during the surgery. Unfortunately, incidents like this are not uncommon. This error was reported in a recently prepared database that has been created by the Association of Health Care Journalists. This database contains 8,000 violations of federal safety regulations that have occurred since January 2011. This particular case is an extreme example of surgical errors. This action violated practices of the Association of perioperative Register Nurses, and it should be a cause of concern for surgeons and medical consumers alike. There was no lawsuit against the hospital involved, and they are now investigating their protocols for vendor representatives involved in procedures.

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